In consideration for receiving permission from the New York Academy of Sciences for my child (named above) to submit this form, I agree as follows:

1. I represent that I am the parent or lawful guardian of the minor child named above.
2. If my child's form submission is accepted, I agree to be responsible for directing and causing my child to adhere strictly to all applicable rules, regulations, policies, guidelines, and instructions of the Academy’s Terms of Use policy, including those concerning safety, general decorum, and conduct.
3. I acknowledge and agree that receipt of my child's form submission is only confirmed after this document has been signed by me.
4. I agree and understand that I am responsible for the actions of my child. I release, discharge, and hold harmless the Academy and their respective officers, directors, staff, and employees to the fullest extent permitted by law, from any and all claims and liabilities, including claims for negligence or gross negligence, which may arise in connection with this program, except those that may arise due to the intentional wrongdoing of an Academy officer, director, staff member, or employee.
5. I agree to permit the Academy and its representatives to make use of my child's image, voice and/or conversation ("likeness") in printed, electronic or other media form, now known or hereafter developed. My child's likeness may be used by the Academy, including public relations, fundraising, promotional, recruitment or educational materials. The media form in which their likeness has been captured may include printed or electronic publications or communications, websites, or other means of distribution or transmission, now known or hereafter developed. I hereby waive any right to inspect or approve any such media and authorize the use of my child's likeness in perpetuity, and without any compensation to me or my child. I hereby assign all right, title and interest in all such media capturing my child's likeness, and agree that all such media shall be owned by the Academy.
6. This Consent, Waiver, and Release shall be governed by and construed and interpreted in accordance with the laws of the State of New York, USA, without regard to conflicts or choice of law rules or principles. All legal actions and proceedings relating in any way to the "Share Your Story_2ec6ba0c-f408-420e-82b5-5ae6e92c0836" form page or this Consent, Waiver, and Release shall be brought exclusively in the federal or state courts sitting in the State of New York, USA, and I waive any objection to jurisdiction and venue in such courts.
7. I hereby give my permission for my child named above to submit this form according to the terms and conditions stated above. By signing below, I confirm that I have fully informed myself of the contents of this consent, waiver, and release by reading it before I signed it, and I have signed and entered into it voluntarily.